A 65-year-old woman comes to the physician for the evaluation of sharp, stabbing pain in the lower back for 3 weeks. The pain radiates to the back of her right leg and is worse at night. She reports decreased sensation around her buttocks and inner thighs. During the last several days, she has had trouble urinating. Three years ago, she was diagnosed with breast cancer and was treated with lumpectomy and radiation. Her only medication is anastrozole. Her temperature is 37°C (98.6°F), pulse is 80/min, respirations are 12/min, and blood pressure is 130/70 mm Hg. Neurologic examination shows 4/5 strength in the left lower extremity and 2/5 strength in her right lower extremity. Knee and ankle reflexes are 1+ on the right. The resting anal sphincter tone is normal but the squeeze tone is reduced. Which of the following is the most likely diagnosis?
AAnterior spinal cord syndrome
BCauda equina syndrome
CConus medullaris syndrome
DCentral cord syndrome
EBrown-sequard syndrome
A 20-year-old man is brought to the emergency department 20 minutes after he sustained a stab wound to his back during an altercation. He reports weakness and numbness of the lower extremities. He has no history of serious illness. On arrival, he is alert and cooperative. His pulse is 90/min, and blood pressure is 100/65 mm Hg. Examination shows a deep 4-cm laceration on his back next to the vertebral column at the level of the T10 vertebra. Neurologic examination shows right-sided motor weakness with diminished vibratory sense ipsilaterally, decreased sensation to light touch at the level of his laceration and below, and left-sided loss of hot, cold, and pin-prick sensation at the level of the umbilicus and below. Deep tendon reflexes of his right lower extremity are 4+ and symmetrical. Babinski sign is absent bilaterally. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?
ABrown-Sequard syndrome
BAnterior cord syndrome
CPosterior cord syndrome
DCauda equina syndrome
ECentral cord syndrome
A 76-year-old woman with hypertension and coronary artery disease is brought to the emergency department after the sudden onset of right-sided weakness. Her pulse is 83/min and blood pressure is 156/90 mm Hg. Neurological examination shows right-sided facial drooping and complete paralysis of the right upper and lower extremities. Tongue position is normal and she is able to swallow liquids without difficulty. Knee and ankle deep tendon reflexes are exaggerated on the right. Sensation to vibration, position, and light touch is normal bilaterally. She is oriented to person, place, and time, and is able to speak normally. Occlusion of which of the following vessels is the most likely cause of this patient's current symptoms?
AIpsilateral anterior cerebral artery
BContralateral middle cerebral artery
CAnterior spinal artery
DContralateral lenticulostriate artery
EIpsilateral posterior inferior cerebellar artery
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